Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Institute of Biometry and Clinical Epidemiology & Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Support Care Cancer. 2022 Jul;30(7):5837-5847. doi: 10.1007/s00520-022-07006-5. Epub 2022 Mar 31.
Cytogenetic testing (CGT) in uveal melanoma patients reveals prognostic information about the individual risk of developing distant metastasis with dismal prognosis. There is currently no medical intervention strategy with proven effect on the prognosis, rendering the result of the cytogenetic testing purely informative. We explored patients' socio-demographic backgrounds, psychological preconditions, coping strategies, external influences, and concerns about "knowing their fate" to study their possible interactions with decision-making for CGT.
Uveal melanoma patients were asked to complete questionnaires on their interest in undergoing CGT for prognostication and the factors influencing their decision. Data were collected on socio-demographics, baseline anxiety (GAD-7), depression (PHQ-9), coping strategies (Brief COPE), and assumed future concerns regarding the CGT result. Data were analyzed by using multiple ordinal logistic regression and exploring estimated marginal effects.
Questionnaires were returned by 121 of 131 (92.4%) patients. Fifty-two patients (43%) had no interest in CGT, 34 (28.1%) were undecided, and 35 (28.9%) were interested. We observed no significant differences regarding age, sex, partnership, education, occupation, baseline anxiety, or depression. Decision-making favoring CGT was influenced by the treating physicians, internet resources, and level of baseline anxiety. Patients were likely to reject CGT when they worried that "knowing the result will have an unintended influence" on their life.
Decision-making about CGT for prognostication in uveal melanoma is burdensome to many patients and in general not guided by medical advice regarding further treatment and screening procedures. The psychological impact of the decision is therefore unique and requires careful support by psycho-oncologists considering the patient's fears and expectations.
葡萄膜黑色素瘤患者的细胞遗传学检测（CGT）揭示了个体发生远处转移的预后风险信息，预后较差。目前，尚无经证实可改善预后的医学干预策略，因此细胞遗传学检测的结果纯属信息性的。我们探讨了患者的社会人口统计学背景、心理前提、应对策略、外部影响以及对“了解自己的命运”的担忧，以研究它们与 CGT 决策之间的可能相互作用。
葡萄膜黑色素瘤患者被要求完成关于是否有兴趣进行 CGT 以预测预后以及影响其决策的因素的问卷。收集了社会人口统计学、基线焦虑（GAD-7）、抑郁（PHQ-9）、应对策略（Brief COPE）以及对 CGT 结果的假设未来担忧的数据。通过使用多元有序逻辑回归和探索估计边际效应来分析数据。
131 名患者中有 121 名（92.4%）返回了问卷。52 名患者（43%）对 CGT 不感兴趣，34 名（28.1%）犹豫不决，35 名（28.9%）感兴趣。我们观察到年龄、性别、伴侣关系、教育、职业、基线焦虑或抑郁方面没有显著差异。有利于 CGT 的决策受到主治医生、互联网资源和基线焦虑水平的影响。当患者担心“了解结果会对他们的生活产生意想不到的影响”时，他们更有可能拒绝 CGT。
许多患者对 CGT 进行预后预测的决策感到负担沉重，通常不受关于进一步治疗和筛查程序的医学建议的指导。因此，决策的心理影响是独特的，需要考虑患者的恐惧和期望，由肿瘤心理学家给予精心支持。
